| NPI | 1548462229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F400785-1) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00051600) |
| 103T00000X Psychologist (Licence: NJ 35S100307400) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2014-01-31 |